MYSTIC HEALTHCARE AND REHABILITATION FACILITY
NPI 1174867113
Clinic/Center - Physical Therapy in Mystic, CT

Active since November 15, 2012CLIA 07D0709627 · Waiver

NPPES record last updated: November 15, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mystic Healthcare And Rehabilitation Facility NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYSTIC HEALTHCARE AND REHABILITATION FACILITY (NPI 1174867113) is a healthcare organization registered as a physical therapy in Mystic, Connecticut and active in the NPI registry since November 2012. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Susan Elizabeth Dorman, Registered Physical Therapist, as its authorized official.

NPPES Registry Identity

NPI1174867113
Entity TypeOrganization
Primary Taxonomy261QP2000X
Legal Business NameMYSTIC HEALTHCARE AND REHABILITATION FACILITY
Location Address475 HIGH STMystic, CT 06355-1707
Mailing Address475 High StMystic, CT 06355-1707
Organization SubpartNo
Authorized OfficialSusan Elizabeth DormanRegistered Physical Therapist · (860) 536-6070
Enumeration DateNovember 15, 2012
NPI 1174867113 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/Center · Physical TherapyAmbulatory Health Care Facilities
Taxonomy Code261QP2000X
License Licensed in CT · 003480
Definition
An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. Physical therapists and physical therapist assistants are licensed health care professionals who are experts in the movement system and help individuals maintain, restore, and improve movement, activity, and functioning, thereby enabling optimal performance and enhancing health, well-being, and quality of life. Their services prevent, minimize, or eliminate impairments of body functions and structures, activity limitations, and participation restrictions. Physical therapy is provided for individuals of all ages who have or may develop impairments, activity limitations, and participation restrictions related to (1) conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems or (2) the negative effects attributable to unique personal and environmental factors as they relate to human performance.
475 HIGH ST, Mystic, CT 06355

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D0709627

Mystic Healthcare And Rehab Center · Mystic, CT
Active · expires Aug 31, 2026
CLIA Number07D0709627
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorVikram Rao
Laboratory Phone(860) 536-6070
Laboratory LocationMystic Healthcare And Rehab Center475 High St, Mystic, CT 06355
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapy Assistant
475 HIGH ST
MYSTIC, CT 06355
Physical Therapist
475 HIGH ST
MYSTIC, CT 06355
Physical Therapy Assistant
475 HIGH ST
MYSTIC, CT 06355
Physical Therapist
475 HIGH ST
MYSTIC, CT 06355

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mystic Healthcare And Rehabilitation Facility's NPI number?

The NPI number for Mystic Healthcare And Rehabilitation Facility is 1174867113. It was assigned to this organization in the NPPES registry on November 15, 2012.

Where is Mystic Healthcare And Rehabilitation Facility located?

Mystic Healthcare And Rehabilitation Facility is located at 475 High St, Mystic, CT 06355. The listed phone number is (860) 536-6070.

What is Mystic Healthcare And Rehabilitation Facility's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Physical Therapy, with taxonomy code 261QP2000X.

Does Mystic Healthcare And Rehabilitation Facility hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D0709627) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mystic Healthcare And Rehabilitation Facility was last updated on November 15, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.